Clinical and Hospital Factors Affecting Treatment with Primary Prevention Implantable Cardioverter-Defibrillators in
Jae Hyuk Lee1, Hee Tae Yu1, Il Young Oh2
1Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
Insights
Primary prevention implantable cardioverter-defibrillator (ICD) use for ischemic cardiomyopathy is low in Korea. Hospital system factors and patient clinical status significantly impact appropriate ICD implantation rates.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Implantable cardioverter-defibrillators (ICDs) are standard for primary prevention (PP) in ischemic cardiomyopathy (ICM).
- PP ICD implantation is notably underutilized in Asian populations.
- This study addresses the low rates and influencing factors of PP ICD implantation in ICM patients.
Purpose of the Study:
- To investigate the current rates of PP ICD implantation among eligible ICM patients in Korea.
- To identify clinical and hospital-related factors associated with appropriate PP ICD implantation.
Main Methods:
- Prospective, multicenter observational registry (ADVANCE-ICM).
- Screening and enrollment of ICM patients eligible for PP ICD.
- Analysis of factors, including hospital systems and patient clinical data, linked to ICD implantation.
Main Results:
- Only 5.2% of 1453 eligible ICM patients received an ICD.
- Higher hospital system scores and non-monetary referral incentives were associated with ICD implantation.
- Multivariate analysis identified hospital system score, high NYHA class (≥III), and younger age (<70) as predictors for ICD implantation.
Conclusions:
- PP ICD implantation for ICM patients remains underused in Korea.
- Hospital system factors play a crucial role in improving PP ICD implantation rates.
- Implementing enhanced screening and referral systems is recommended to increase PP ICD utilization.
Purpose:
Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemic cardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM.
Materials And Methods:
In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who were eligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital and clinical factors, were investigated.
Results:
Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0-78.0) years], only 76 (5.2%) patients underwent ICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and total hospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospital system score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10-1.50] was an independent factor for predicting ICD implantation, along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97-17.87) and younger age (<70 years: OR, 2.14; 95% CI, 1.30-3.53).
Conclusion:
PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICD implantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantation rate (Clinical trial registration No. NCT03590925).
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